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About the Business Rules Processor and Claims Logic


Much of the logic for Siebel Insurance is implemented using the Business Rules Processor (BRP) business service. The BRP is appropriate for business logic that can be modified, and you can modify claims business logic without deploying a new SRF. Because BRP is a business service, it can be called from workflow processes. For more information about using the BRP, see Business Rule Processor.

Table 24 shows the BRP business rules processes for claims.

Table 24. BRP Business Rules Processes for Claims
BRP Name
Description
Used In

FINS Claims Evaluate Subrogation Potential

Calculates the Subrogation Real Time score.

Evaluate Subrogation Potential button in MyClaims view

FINS Claims Calculate Combined Score

Calculates the Subrogation Combined score.

Field that drives the subrogation indicator in MyClaims view

FINS Claims Calculate Fraud Score

Calculates the combined Fraud Potential score based on the Real time Rule score, Real time Predictive Model score, and Batch Predictive Model score.

Field that drives the fraud indicator in MyClaims view

FINS Claims Evaluate Fraud Potential

Evaluates the Fraud Potential score.

Evaluate SIU Potential button in MyClaims view

FINS Claims Reserve Estimation Check BRP

Compares the Total Estimation amount with the Total Reserve amount.

Claims, then the Appraisals view

FINS Claims Authority Limit Check

Performs the authority limit check before the reserve is opened.

Open Reserve button in Claims, then the Reserves view

FINS Claims Split Limit Check

Performs checks on the limits for reserve claims.

Open Reserve button in Claims, then the Reserves view

FINS Claims Calculate SIU Expenses

Calculates the SIU Total Expenses.

Task link in SIU dashboard view

FINS Claims Calculate Total Conservation Amount

Calculates the Conservation Amount.

Task link in SIU dashboard view

FINS Claims Calculate Total Payment Amount

Calculates the Total Claim Payments amount.

Task link in SIU dashboard view

FINS Claims Create Fraud Case Assignment Alert

Creates an alert for a fraud case assignment.

Task link in SIU dashboard view

FINS Claims Calculate Subrogation Expenses

Calculates the Subrogation Total Expenses.

Task link in Recovery view

FINS Claims Calculate Deductible Return

Calculates the Subrogation Deductible Return amount.

Task link in Recovery view

FINS Claims Create Subrogation Case Assignment Alert

Creates a subrogation case assignment alert.

Task link in Recovery view

FINS Claims Set Notify Salvage

Sets the Notify Salvage flag.

Notify Salvage flag in Recovery view

FINS Claims Subrogation Reassignment

Reassigns the claim to a subrogation specialist.

Task link in Recovery view

FINS Claims Subrogation Update BC Fields

Updates the subrogation fields for Recovery Potential or Update Theory of Liability tasks.

Task link in Recovery view

FINS Claims Fraud Litigation Assignment

Performs the Claims fraud Arbitration Litigation assignment.

Task link in Recovery view

FINS Claims SIU Reassignment

Reassigns the claim to a fraud specialist.

Task link in SIU dashboard view

FINS Claims Fraud Update BC Fields

Updates business component fields when the Update Recovery Potential or Update Probability Of Resolution link is clicked.

Task link in SIU dashboard view

FINS Claims Subrogation Arbitration Litigation Assignment

Assigns the claim to a subrogation arbitration or litigation unit.

Task link in Recovery view

FINS Claims Subrogation Collections Assignment

Assigns the claim to a subrogation collections unit.

Task link in Recovery view

FINS Claims Subrogation Check State Statutes

Checks the State Statutes.

Task link in Recovery view

FINS Claims Assign SIU Opportunity

Assigns the claims to the SIU unit when the user clicks the Notify SIU button.

Notify SIU button in MyClaims view

FINS Claims Assign Subrogation Opportunity

Assigns the claims to the subrogation unit when the user clicks the Notify Subro button.

Notify Subro button in MyClaims view

FINS Claims Invoke Assignment Manager

Invokes the Assignment Manager component.

All assignment buttons and assignment links.

FINS Claims Check OFAC Status For Contact Payees

Checks and updates the OFAC-related fields for the Contact payees during the Submit Payment processing.

Submit Payment button in Claims, then the Payments view

FINS Claims Check OFAC Status For Vendor Payees

Checks and updates the OFAC-related fields for the Vendor payees during the Submit Payment processing.

Submit Payment button in Claims, then the Payments view

FINS Claims Payment Update Reserves

Updates the Reserve fields during the Submit Payment processing.

Submit Payment button in Claims, then the Payments view

FINS Claims Payment Validate Reserves

Validates the Reserve fields during the Submit Payment processing.

Submit Payment button in Claims, then the Payments view

FINS Claims Reserve Adjustment

Changes the Status from Pending - Open to Open when a user clicks the Reserve Adjustment button.

Reserve Adjustment button in Claims, then the Reserves view

FINS Claims Add Reserve Position to Claim Team

Adds the Reserve position to the Claim team.

Open Reserve button in Claims, then the Reserves view

FINS Claims Manual Override Flag

Sets the Manual Override flag. If the reserve is of type Factor and the Allow Override flag is set, and if the reserve amount is changed, the Manual Override flag is set to true.

Claims, then the Reserves view

FINS Claims Void Payment Reserves Process

Cancels the submitted payment.

Void payment button in Claims, then the Payments view

FINS Claims Apply Deductible For Reserve

Applies the deductible flag for the reserve across payments.

Apply Deductibles flag in Claims, then the Payments view

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